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Site Address: 16 E HARDING WAY Date of Testin ervicing: <br /> F. In-Tank Gauging/ SIR Equip at: Check this box if tank. aging is used only for inventory control. <br /> 16 E HARDING WAY Check this box if no tank gauging or SIR equipment is installed. <br /> This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. <br /> Complete the following checklist: <br /> Yes No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? <br /> s . Yes p No* Were all tank gauging probes visually inspected for damage and residue buildup? <br /> j Yes p No* Was accuracy of system product level readings tested? <br /> Yes No* Was accuracy of system water level readings tested? <br /> Yes No* Were all probes reinstalled properly? <br /> Yes No* Were allitems on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be correcte d. <br /> G. Line Leak Detectors (LLD): Check this box ifLLD s are not installe d. <br /> Com the following checklist: <br /> - _ es No* For equipment start-up or annual equipment ce cation, was a leak simulated to verify LLD performance? <br /> A NIA (Check all That apply) Simulated leak rate: g.p.h.l; 0.1 g.p.h.�; 0.2 g.p.h.2 <br /> Notes: 1. Required for equipment startup certification and annual certification. <br /> 2. Unless mandated by local agency, certification required only for electronic LLD start-up. <br /> e No* Were alILLDs confirmed operational and accurate within regulatory requirements? <br /> 2ryes ( No* Was the testing apparatus properly calibrated? <br /> Yes IR Not For mechanical LLDs, does the LLD restrict product flow if it detects aleak? <br /> RryIA <br /> es } No* For electronic LLD s, does the turbine automatically shut off if the LLD detects aleak? <br /> NIA <br /> es No* For electronic LLD s, does the turbine automatically shut off if any portion of the monitoring system is disabled <br /> NIA or disconnected? <br /> _ es No* For electronic LLDs, does the turbine automatically shut off if any portion of the monitoring system malfunctions <br /> NIA or fails ate st? <br /> __ es No* For electronic LL.Ds,have all accessible wiring connections been visually inspected? <br /> NIA <br /> es No* Were all items on the equipment manufacturer's maintenance checklist completed? <br /> *In the Section H,below,describe how and when these deficiencies were or will be corrected. <br /> i H. Comments: j <br /> i <br /> Page 3 of 3 0101 <br />